Yield of Dual Therapy With Statin and Ezetimibe in the Treat Stroke to Target Trial

被引:15
作者
Amarenco, Pierre [1 ,2 ,3 ]
Kim, Jong S. [4 ]
Labreuche, Julien [5 ]
Charles, Hugo [1 ,2 ]
Giroud, Maurice [6 ]
Lee, Byung-Chul [7 ]
Lavallee, Philippa C. [1 ,2 ]
Mahagne, Marie-Helene [8 ]
Meseguer, Elena [1 ,2 ]
Nighoghossian, Norbert [9 ,10 ]
Steg, Philippe Gabriel [11 ,12 ]
Vicaut, Eric [13 ]
Bruckert, Eric [14 ]
机构
[1] Univ Paris, Bichat Hosp, AP HP, INSERM LVTS U1148,DHU FIRE,Dept Neurol, Paris, France
[2] Univ Paris, Bichat Hosp, Stroke Ctr, INSERM LVTS U1148,DHU FIRE, Paris, France
[3] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
[4] Asan Med Ctr, Seoul, South Korea
[5] CHU Lille, Dept Biostat, Lille, France
[6] Univ Burgundy, Univ Hosp Dijon, Dept Neurol, EA 7460,Dijon Stroke Registry,UBFC, Dijon, France
[7] Hallym Univ, Dept Neurol, Sacred Heart Hosp, Anyang, South Korea
[8] Pasteur Hosp, Stroke Unit, Nice, France
[9] Lyon Univ, Hosp Civils Lyon, Dept Neurol, Lyon, France
[10] Lyon Univ, Stroke Ctr, Lyon, France
[11] Univ Paris, INSERM LVTS U1148, Paris, France
[12] Hop Bichat Claude Bernard, AP HP, Paris, France
[13] Univ Paris Diderot, Fernand Widal Hosp, AP HP, Dept Biostat,Sorbonne Paris Cite, Paris, France
[14] Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Endocrinol, Paris, France
关键词
ezetimibe; lipoproteins; LDL; stroke; ATORVASTATIN; METAANALYSIS; CHOLESTEROL; PREVENTION; REDUCTION; EFFICACY; SAFETY;
D O I
10.1161/STROKEAHA.122.039728
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: In atherosclerotic stroke, lipid-lowering treatment with a target LDL (low-density lipoprotein) cholesterol of <70 compared with 100 +/- 10 mg/dL reduced the risk of subsequent cardiovascular events. This post hoc analysis explored the relative effects of the combination of statin and ezetimibe (dual therapy) and statin monotherapy in achieving the lower LDL cholesterol target and in reducing the risk of major vascular events, as compared with the higher target group. METHODS: Patients with ischemic stroke in the previous 3 months or transient ischemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis were randomly assigned to a target LDL cholesterol of <70 or 100 +/- 10 mg/dL, using statin and/or ezetimibe as needed. The primary outcome was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization, and vascular death. Cox regression model including lipid-lowering therapy as a time varying variable, after adjustment for randomization strategy, age, sex, index event (stroke or transient ischemic attack), and time since the index event. RESULTS: Among 2860 patients enrolled, patients who were on dual therapy during the trial in the lower target group had a higher baseline LDL cholesterol as compared to patients on statin monotherapy (141 +/- 38 versus 131 +/- 36, respectively, P<0.001). In patients on dual therapy and on statin monotherapy, the achieved LDL cholesterol was 66.2 and 64.1 mg/dL respectively, and the primary outcome was reduced during dual therapy as compared with the higher target group (HR, 0.60 [95% CI, 0.39-0.91]; P=0.016) but not during statin monotherapy (HR, 0.92 [95% CI, 0.70-1.20]; P=0.52), with no significant increase in intracranial bleeding. CONCLUSIONS: In the TST trial (Treat Stroke to Target), targeting an LDL cholesterol of < 70 mg/dL with a combination of statin and ezetimibe compared with 100 +/- 10 mg/dL consistently reduced the risk of subsequent stroke.
引用
收藏
页码:3260 / 3267
页数:8
相关论文
共 13 条
[1]  
Agence Francaise de Securite Sanitaire des Produits de Sante, 2005, Rev Prat, V55, P1788
[2]   A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke [J].
Amarenco, P. ;
Kim, J. S. ;
Labreuche, J. ;
Charles, H. ;
Abtan, J. ;
Bejot, Y. ;
Cabrejo, L. ;
Cha, J-K ;
Ducrocq, G. ;
Giroud, M. ;
Guidoux, C. ;
Hobeanu, C. ;
Kim, Y. J. ;
Lapergue, B. ;
Lavallee, P. C. ;
Lee, B-C ;
Lee, K-B ;
Leys, D. ;
Mahagne, M-H ;
Meseguer, E. ;
Nighoghossian, N. ;
Pico, F. ;
Samson, Y. ;
Sibon, I ;
Steg, P. G. ;
Sung, S-M ;
Touboul, P. J. ;
Touze, E. ;
Varenne, O. ;
Vicaut, E. ;
Yelles, N. ;
Bruckert, E. .
NEW ENGLAND JOURNAL OF MEDICINE, 2020, 382 (01) :9-19
[3]   Treat stroke to target trial design: First trial comparing two LDL targets in patients with atherothrombotic strokes [J].
Amarenco, Pierre ;
Kim, Jong S. ;
Labreuche, Julien ;
Giroud, Maurice ;
Lee, Byung-Chul ;
Mahagne, Marie-Helene ;
Nighoghossian, Norbert ;
Simon, Tabassome ;
Steg, Philippe Gabriel ;
Touboul, Pierre-Jean ;
Vicaut, Eric ;
Yelles, Nessima ;
Bruckert, Eric .
EUROPEAN STROKE JOURNAL, 2019, 4 (03) :271-280
[4]   Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention [J].
Amarenco, Pierre ;
Labreuche, Julien .
LANCET NEUROLOGY, 2009, 8 (05) :453-463
[5]  
Amarenco P, 2006, NEW ENGL J MED, V355, P549
[6]  
[Anonymous], 2013, CLIN PRACTICE GUIDEL
[7]   Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials [J].
Baigent, C. ;
Blackwell, L. ;
Emberson, J. ;
Holland, L. E. ;
Reith, C. ;
Bhala, N. ;
Peto, R. ;
Barnes, E. H. ;
Keech, A. ;
Simes, J. ;
Collins, R. .
LANCET, 2010, 376 (9753) :1670-1681
[8]   Interpretation of the evidence for the efficacy and safety of statin therapy [J].
Collins, Rory ;
Reith, Christina ;
Emberson, Jonathan ;
Armitage, Jane ;
Baigent, Colin ;
Blackwell, Lisa ;
Blumenthal, Roger ;
Danesh, John ;
Smith, George Davey ;
DeMets, David ;
Evans, Stephen ;
Law, Malcolm ;
MacMahon, Stephen ;
Martin, Seth ;
Neal, Bruce ;
Poulter, Neil ;
Preiss, David ;
Ridker, Paul ;
Roberts, Ian ;
Rodgers, Anthony ;
Sandercock, Peter ;
Schulz, Kenneth ;
Sever, Peter ;
Simes, John ;
Smeeth, Liam ;
Wald, Nicholas ;
Yusuf, Salim ;
Peto, Richard .
LANCET, 2016, 388 (10059) :2532-2561
[9]   Definition and Evaluation of Transient Ischemic Attack A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. [J].
Easton, J. Donald ;
Saver, Jeffrey L. ;
Albers, Gregory W. ;
Alberts, Mark J. ;
Chaturvedi, Seemant ;
Feldmann, Edward ;
Hatsukami, Thomas S. ;
Higashida, Randall T. ;
Johnston, S. Claiborne ;
Kidwell, Chelsea S. ;
Lutsep, Helmi L. ;
Miller, Elaine ;
Sacco, Ralph L. .
STROKE, 2009, 40 (06) :2276-2293
[10]   Benefit of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes and Safety in Patients With Versus Without Diabetes Mellitus Results From IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) [J].
Giugliano, Robert P. ;
Cannon, Christopher P. ;
Blazing, Michael A. ;
Nicolau, Jose C. ;
Corbalan, Ramon ;
Spinar, Jindrich ;
Park, Jeong-Gun ;
White, Jennifer A. ;
Bohula, Erin A. ;
Braunwald, Eugene .
CIRCULATION, 2018, 137 (15) :1571-+